A.27

Question 1

Selective monoamine reuptake inhibitors

Answer 1

Fluoxetine,
Sertraline,
(es)citalopram,
Venlafaxine,
Duloxetine,
Reboxetine

Question 2

Fluoxetine, Sertraline, (es)citalopram

Answer 2

MOA: SSRIs → Fluoxetine 5HT2C- antagonist, selective 5HT reuptake inhibitors, little antagonism of M, H1, α1 receptors (→ less SEs);
IND: 1st line (GOLD STANDARD!) treatment against depression-2 weeks to show improved mood (4-6w for max benefit), generalized anxiety disorder, OCD, PTSD, bulimia;
Contra-IND: pregnancy;
SEs: CNS- anxiety (in the beginning of therapy), hallucinations (rarely), insomnia, headache, sexual dysfunction. GI (mainly due to 5HT3)- weight gain, nausea, vomiting, diarrhea. Cardiac- QT elongation. Abrupt discontinuation- paresthesia→sertralin. Serotonin syndrome;
ROA: p.o (→citalopram (1X20mg);
Extra: Hepatic metabolism by CYP2C19, Fluoxetine inhibits CYT P450

Question 3

Venlafaxine, Duloxentine

Answer 3

MOA: SSNRIs→ selective inhibition of 5HT + NE reuptake, little antagonism of M, H1, α1 receptors (→ less SEs);
IND: Neuropathy, fibromyalgia, anxiety disorders, depression (in patients that don’t respond to SSRIs); SEs: ↑serotonergic tone→ GI disturbances, sexual dysfunction. ↑NA tone→ tachycardia, arrhythmia;
Extra: hepatic metabolism by CYP2D6, venlafaxine has the shortest T1/2

Question 4

Reboxetine

Answer 4

MOA: SNRIs→ selective NE reuptake inhibitor;
IND: less commonly used AD;
Effect: increases mental alertness, motivation, activity; SEs: weak anti-M effect- dry mouth, pseudo anti-cholinergic symptoms- HTN, constipation;
Extra: hepatic metabolism by CYP2D6

Question 5

paresthesia

Answer 5

tickling sensation

Question 6

pseudo anti-cholinergic symptoms

Answer 6

seems like anti-cholinergic peripheral effect but actually caused by increase in NE concentration in periphery

Question 7

Serotonin syndrome

Answer 7

↑serotonergic tone →triad of symptoms:
Cognitive (Delirium, Coma, Agitation)
Autonomic (HTN, tachycardia)
Somatic (hyperreflexia, hyperthermia, tremor)
This is more common when SSRIs are given with MAO-Is

Question 8

treatment for serotonin syndrome

Answer 8

Cyproheptadine, it is a 5-HT antagonist and blocks 5-HT2-Rs